CNA vs HHA vs DSP: What's the Difference?

The comparison at a glance

CNA, HHA, and DSP are three of the most common job titles in hands-on caregiving in the U.S., and they're often used interchangeably in casual conversation. The roles do overlap — but each one comes with a distinct credential, a typical employer, a usual payer, and a different supervision model. Here's how each fits into the broader healthcare and human-services system.

• CNA (Certified Nursing Assistant) — State-certified through the TN CNA registry after roughly 75 hours of training and a state exam. CNAs work across nursing facilities, hospitals, and home care agencies under RN or LPN supervision; care is paid through Medicaid, Medicare, private pay, or long-term care insurance.
• HHA (Home Health Aide) — Trained through an HHA program (state-cert requirements vary). HHAs typically work at Medicare-certified home health agencies (CON-holding in Tennessee) under RN supervision and physician orders, providing care during the time-limited window after a hospital stay when Medicare home-health benefits apply.
• DSP (Direct Support Professional) — Trained through agency-specific programs, typically without state certification. DSPs most often work at disability service providers and Medicaid HCBS waiver agencies (DIDD or ECF CHOICES in Tennessee), supporting adults with intellectual or developmental disabilities. Some agencies, including Resource One, use "DSP" as a broader caregiver job title.

What a CNA actually does

A Certified Nursing Assistant in Tennessee completes a state-approved training program — usually around 75 hours — and passes a state competency exam to be listed on the CNA registry. CNAs work in a wide range of settings: skilled nursing facilities, hospitals, assisted living communities, and home care agencies. Day-to-day, the role centers on hands-on personal care, basic clinical observation, and documentation that supports the care team's decisions.

• Bathing, dressing, grooming, and toileting
• Mobility, transfers, and safe positioning
• Vital sign measurement (blood pressure, temperature, pulse, respirations)
• Meal preparation, feeding assistance, and intake/output tracking
• Medication observation (administration handled by RN/LPN in clinical settings)
• Documentation of care provided and observations of patient/client status

In home care, CNA work looks different from facility work. The team is smaller, the schedule is more flexible, and the CNA usually serves the same one-to-three clients on a regular rotation — not a hallway of 12 patients with new faces each shift. Resource One's CNAs work the same way: community-based assignments, fewer clients per caregiver, and the same patient over weeks or months.

What an HHA actually does

A Home Health Aide is typically employed by a Medicare-certified home health agency — in Tennessee, that means a CON-holding (Certificate of Need) provider. HHA work happens during a defined Medicare benefit window after a hospitalization or qualifying event, under the supervision of a registered nurse and physician orders. The role is time-limited and clinically observed.

• ADL support during scheduled visits — bathing, mobility, basic personal care
• Vital sign documentation for the supervising RN's review
• Reporting changes in condition (skin breakdown, falls, mood changes) to the RN
• Light household tasks within Medicare's narrow scope (meal prep for the patient, light tidying around their care space)
• Re-evaluation visits coordinated with the home-health nurse and the physician's plan of care

What a DSP actually does

A Direct Support Professional, in the industry-standard meaning, supports adults with intellectual or developmental disabilities (IDD) — typically through a state Medicaid HCBS waiver. In Tennessee, DSP work is most often funded through DIDD (Department of Intellectual and Developmental Disabilities) or ECF CHOICES contracts. The DSP role goes beyond personal care: it includes community engagement, behavioral support, and coaching toward goals in an Individual Support Plan (ISP).

• Personal care — bathing, grooming, dressing, mobility, hygiene
• Household tasks — meal prep, laundry, light cleaning
• Transportation to community activities, jobs, social events, and medical appointments
• Coaching ISP goals — communication, daily living skills, vocational steps, social skills
• Behavioral support strategies (often per a behavior support plan)
• Medication assistance under agency-specific rules and supervisor approval
• Engagement and recreation — being a steady, supportive presence

This title-vs-specialty distinction matters when you're researching the role. Most US DSP jobs are IDD-focused. At Resource One, you might be hired into the DSP title and work primarily with elderly clients in their homes — same job duties as our CNAs and caregivers, just a different label tied to how Tennessee's funding and credentialing systems happen to work.

Which one do I need?

Whether you're hiring care for a loved one or considering a caregiving career, the choice between CNA, HHA, and DSP comes down to a few practical questions: Who's paying? What kind of supervision and credentialing does that funder require? What setting will the work happen in?

• For families hiring care: CNA-staffed home care fits when you need state-credentialed scope and steady ongoing support. HHA-staffed home health fits when you have a Medicare home-health benefit after a hospitalization. DSP-staffed support fits when you're supporting an adult with IDD through a Medicaid waiver.
• For aspiring caregivers — CNA path: the most portable credential, broadest job options, opens doors in nursing facilities, hospitals, and home care.
• For aspiring caregivers — DSP path: community-based work, often emphasizes engagement and skill-building over clinical observation, no state cert typically required.
• For aspiring caregivers — HHA path: narrower medical-side niche, time-limited Medicare benefit context, step-up path to RN through CNA training.

If you're researching home care for a family member, see our private duty home care or TennCare CHOICES service pages for how Resource One delivers care across these funding models. If you're considering a caregiving career, our caregiver and CNA jobs pages cover what working at Resource One actually looks like.